CHAPTER 9  
             Structural-Strategic Approaches to Couple and 
                               Family Therapy  
                          VICTORIA BEHAR MITRANI, PhD  
                           MARIA ALEJANDRA PEREZ, BA  
                                 University of Miami  
                                  INTRODUCTION 
       Other textbooks on family and couple therapy have had separate chapters for the
       structural and strategic approaches. In this volume, the two models, structural family
       therapy, as developed by Salvador Minuchin, and strategic family therapy, as developed
       by Jay Haley, are presented together because of their common emphasis on systems and
       structure. Both approaches aim to realign family organization to produce change in the
       entire system, and both are focused on the hierarchical organization of the family. We
       have chosen to highlight the branch of strategic family therapy developed by Jay Haley
       because of its structural framework. Other strategically oriented approaches are no less
       influential than Haley’s and have, in fact, been precursors to many of the dominant 
       movements in modern family therapy approaches. 
         There are key points of divergence between Minuchin’s and Haley’s approaches, 
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       however. The structural approach emphasizes family organizations composed o
       subsystems and focuses on boundaries between subsystems. The strategic approach
       focuses on repeating sequences of behavior, particularly those that break hierarchical
       rules through cross-generational coalitions. Structural therapists focus on resolving 
       structural problems in the family, whereas strategic therapists focus on the presenting
       symptom. Although both therapeutic approaches are action- and present-oriented, 
       structuralists utilize interpretation and tasks in the form of enactment, whereas strategists
       shun interpretation and utilize both straightforward and paradoxical directives. Minuchin
       and Fishman (1981) highlight another key difference: “The strategic therapist sees the 
       symptom as a protective solution: the symptom bearer sacrifices himself to defend the
       family homeostasis. The structuralist, regarding the family as an organism, sees this
                                                                         r 
       protection not as a purposeful, ‘helpful’ response, but as a reaction of an ‘organism unde
       stress’” (p. 68).  
         Each section of the chapter presents elements that are common across approaches, as 
       well as elements that are unique to each. This chapter draws heavily from seminal
       writings, including Minuchin’s Families and Family Therapy (1974), Minuchin and 
       Fishman’s Family Therapy Techniques (1981), Haley’s Problem-Solving Therapy (1987), 
       and Madanes’s Strategic Family Therapy (1981). Other publications were also influential 
       and are cited when appropriate. 
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                         Handbook of Family Therapy     204
              HISTORY AND BACKGROUND OF THE STRUCTURAL AND 
                           STRATEGIC APPROACHES 
                               Common Elements 
       Both structural and strategic approaches stem from communication theory as advanced
       by Bateson and colleagues—most notably, Don Jackson, John Weakland, and Gregory 
       Bateson, in Palo Alto (Bateson & Jackson, 1968; Bateson, Jackson, Haley, & Weakland,
                                                                   r
       1956). This group began its work in the area of schizophrenia but laid the groundwork fo
       family therapy with all types of symptoms. Communication theory incorporates Wiener’s 
       (1948) theory of cybernetics, to emphasize relationships as homeostatic systems with
       selfcorrecting feedback processes, positing that human relationships are defined by the
       interchange of messages. Behavior is viewed in the context of a unit of at least two
       people, a sender and a receiver. Bateson proposed that communication can be described
       in terms of levels, describing how these levels can conflict in paradoxical ways. By 1962,
       the Palo Alto group had made the shift from describing mental illness as individual
       phenomena to describing it as communicative behavior between people. They identified
       processes that became the building blocks of the structural/ strategic approaches: the
       double bind, the focus’ on dyadic interactions, family homeostasis, and complementarity
       versus symmetry. Subsequent therapies developing out of this view emphasized changing
       families by influencing family members to communicate in new ways. 
        Don Jackson was the first to apply communications theory to family treatment. Jackson
       recognized that family relationships consist of repetitive patterns of interactions. He
       outlined three types of patterns that exist in all families: (1) covert norms, (2) overt
       family values, and (3) metarules for enforcing norms and values. Jackson planted the
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       seeds for the strategic concepts of the function of the symptom and the importance o
       hierarchical structures and “quid pro quo” arrangements in marriage (Jackson, 1965). He
       established the Mental Research Institute (MRI) in 1959 and, together with Haley,
       Watzlawick, Weakland, Virginia Satir, Jules Riskin, and other colleagues, started one of
       the first family therapy training programs (cf., Satir, 1964; Watzlawick, Beavin, &
       Jackson, 1967). 
        The MRI group in Palo Alto has had a tremendous impact on the family therapy field. 
       In addition to being the birthplace of Haley’s approach, it directly and indirectly
       influenced a host of strategically oriented models and therapists. Most prominent are the
       MRI model (cf. Fisch, Weakland, & Segal, 1982; Watzlawick, Weakland, & Fish, 1974), 
       the Milan model (cf. Selvini Palazzoli, Boscolo, Cecchin, & Prata, 1978) and solution-
       focused therapy (cf. de Shazer, 1988). The strategically oriented models are based on
       communications theory and the work of Milton Erickson. The model most closely related
       to Haley’s strategic family therapy is the MRI model. They share a belief that symptoms
       are caused by repetitive sequences of behaviors that repre-sent the family’s faulty 
       attempts to solve problems, resulting in the escalation of problems through positive
       feedback loops. They are both brief, pragmatic, and directive, focusing on identifying and
       resolving the presenting problem, rather than on offering interpretations or providing
  Copyright © 2003. Brunner-Routledge. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S.or applicable copyright law.
         EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 4/4/2012 8:36 PM via ATHABASCA UNIV
         9780203490419 ; Sexton, Thomas L., Weeks, Gerald R., Robbins, Michael S..; Handbook of Family Therapy
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                   Structural-strategic approaches to couple     205
      insight. Both use paradoxical directives and make strategic use of the family’s resistance 
      to bring about change, placing responsibility on the therapist for making change happen
      in the family. Haley’s approach differs from that of MRI, in that it focuses on triadic and 
      moderate-length sequences, rather than on dyadic and immediate sequences of behavior,
      and theorizes about the function of the symptom. However, the most fundamental
      difference between the approaches is that despite focusing on the presenting symptom,
      the ultimate goal in Haley’s model is to change family structure. It is this structural
      framework, particularly with regard to hierarchy, that links Haley’s strategic family 
      therapy to the structural approach. In the sections that follow, we highlight the critical
      influence of Minuchin and Haley and include other important figures who have played a
      role in the refinement of these approaches. Most notable are Braulio Montalvo, on the
      structural side, and Cloe Madanes, the codeveloper of strategic family therapy. 
                          Structural Family Therapy 
      Minuchin came to family therapy in the 1950s, from a background in child psychiatry.
      While working with juvenile delinquents at the Wiltwyck School for Boys, Minuchin and
      colleagues (Auerswald, King, Montalvo, and Rabinowitz) were confronted by the
      impotence of the individual approach, given the social context to which the children
      would return. They were influenced by Jackson’s emphasis on interpersonal connections
      and recognized that the behavior of their patients was not only an action, but also a
      reaction. They started to conduct conjoint sessions, built a therapy room with a one-way 
      mirror, and taught themselves family therapy by trial and error. Minuchin’s work is quite 
      unique because, from the very beginning, he has primarily worked with poor, ethnic
                                                       Families of 
      minority families (cf. Minuchin, Montalvo, Guerney, Rosman, & Schumer, 
      the Slums, 1967). 
        In 1965, Minuchin became professor of psychiatry at the University of Pennsylvania 
      and director of both the Philadelphia Child Guidance Clinic and the Children’s Hospital 
      of Philadelphia’s Department of Psychiatry. Upon his arrival, Minuchin began to rebel
      against the psychiatric establishment and was deemed “dangerous” for zealously insisting 
      that child psychiatry was family psychiatry, even for middle-class families. At about this 
      time, Minuchin also started to treat the families of diabetic children who had been
      unsuccessfully treated with individual therapy. He discovered that all of the families had
      a common view of themselves as normal families who would be happy except for the
      diabetes, and that parents detoured their conflict through the diabetic child. Minuchin
      conducted clinical research with families of diabetic, anorectic, and asthmatic children, as
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      well as those with other psychosomatic complaints, demonstrating the effectiveness o
      family therapy for psychosomatic children (cf., Minuchin, Rosman, Baker, Liebman,
      Milman, & Todd, 1975; Minuchin, Rosman, & Baker, 1978). 
        In the 1970s Minuchin and colleagues at the Philadelphia Child Guidance Clinic 
      (Aponte, Fishman, Greenstein, Haley, Madanes, Montalvo, Rosman, Umberger, and
      Walters) shaped the structural approach into the most influential family therapy approach
                                                             f
      and, due in large part to this work, family therapy was accepted in the mainstream o
      child psychiatry.  
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                        Handbook of Family Therapy     206
                            Strategic Family Therapy 
      Jay Haley worked closely with and was influenced by the Palo Alto group, Milton
      Erickson, and Minuchin. Consequently, strategic family therapy is an integration of
      several seminal streams of family theory. From the Palo Alto/MR group, Haley acquired
      the communication theorists’ understanding of the nature of analogical and digital
      communication (Bateson & Jackson, 1968) and the belief that giving families insight into
      the roots of their problems was not helpful. From Minuchin, he developed the structural
      view of family organization as a holding framework for his strategic techniques. Perhaps
      most important, from Erickson he borrowed many of the cornerstones of the strategic
      approach: the focus on symptoms, the use of paradox, the brevity of treatment, and the
      stance that the therapist should take responsibility for treatment failures. Haley added a
      focus on the functional quality of symptoms. Later, he adopted structural concepts and
      widened the lens on problematic communication to include longer sequences with three
      (triangles) or more people. Haley and Madanes worked together at Palo Alto/MRI and the
      Philadelphia Child Guidance Clinic and established the Family Therapy Institute in
      Washington, DC. 
                      MAJOR THEORETICAL CONSTRUCTS 
                              Common Elements 
      The structural and strategic approaches share many fundamental principles. The first is
      that human behavior, including psychopathology, must be understood within the context
      in which it occurs. Human contexts are systems with rules that regulate behavior and 
      reciprocal processes, such that the behavior of one part of the system influences the 
      behavior of other parts. The most influential human context is the family system. Over
      time, the family develops structures, that is, consistent, repetitive, organized, and 
      predictable patterns of family behavior. The family is a selfcorrecting, homeostatic
      system, in which deviance from the normative pattern of interaction activates a governing
      process. If a person deviates from the repeating behavior and so defines a different
       interaction, the others react against that deviation and shape the behavior back into the
                                       perpetuating and resistant to change, but 
       habitual pattern. Thus family structures are self-
      they are changeable. The goal of therapy is to increase the flexibility and complexity of
      these structures. 
                            Structural Family Therapy 
      One of the goals of the structural approach is to help individuals to experience
      themselves, including their problems, as belonging to part of a larger whole. When the
      individual is seen as part of a larger entity, his or her behavior can be understood as
      complementary or reciprocal to another’s behavior. Complementarity is the defining
      principle of every relationship, in that one person’s behavior is codetermined by 
      another’s behavior. For example, one parent’s leniency is balanced by the other parent’s 
  Copyright © 2003. Brunner-Routledge. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S.or applicable copyright law.
         EBSCO Publishing : eBook Collection (EBSCOhost) - printed on 4/4/2012 8:36 PM via ATHABASCA UNIV
         9780203490419 ; Sexton, Thomas L., Weeks, Gerald R., Robbins, Michael S..; Handbook of Family Therapy
         : The Science and Practice of Working With Families and Couples
         Account: s5055931